Palliative Potts shunt for the treatment of children with drug-refractory pulmonary arterial hypertension: updated data from the first 24 patients

Abstract

Palliative Potts shunt allows prolonged survival and dramatic, long-lasting improvement in functional capacities in children with severe, drug-refractory PAH. The Potts shunt might be considered as a first surgical or interventional step in the management of children with severe, drug-refractory PAH, leaving the door open for further lung transplantation, if needed.

Potts Shunt in Patients with Suprasystemic Pulmonary Arterial Hypertension: Does the Size Matter?

“…The intervention is being performed as a direct "unrestricted" anastomosis with a diameter that is close to diameter of the descending aorta [2][3][4]. Our results of 9 Potts shunts are consistent with the literature data.…”

“…Relatively limited experience with Potts shunt in patients with suprasystemic pulmonary arterial hypertension demonstrates good immediate and follow-up results [3,4]. The intervention is being performed as a direct "unrestricted" anastomosis with a diameter that is close to diameter of the descending aorta [2][3][4].…”

“…Potts shunt performed in this category of patients, transforms hemodynamics of suprasystemic pulmonary arterial hypertension into hemodynamics that is equivalent to Eisenmenger syndrome associated with patent ductus arteriosus. As a result, pulmonary hypertension goes down to systemic level, compression of the left cardiac chambers decreases, and systemic blood flow increases due to the venous blood flow coming from the left pulmonary artery to descending aorta [2][3][4]. Patients with pulmonary arterial hypertension subjected to Potts shunt have to pay price of moderate hypoxemia of the lower extremities.…”

“…Patients with pulmonary arterial hypertension subjected to Potts shunt have to pay price of moderate hypoxemia of the lower extremities. However, this is rewarded by decrease in right ventricular failure, reduced risk of syncopal episodes and sudden death as well as by improvement in functional status.Relatively limited experience with Potts shunt in patients with suprasystemic pulmonary arterial hypertension demonstrates good immediate and follow-up results [3,4]. The intervention is being performed as a direct "unrestricted" anastomosis with a diameter that is close to diameter of the descending aorta [2][3][4].…”

“…Right-to-left shunt at the atrial level created by atrioseptostomy, decompresses right cardiac chambers and increases left chamber preload. At the same time, this procedure causes hypoxemia of not only the lower but also the upper part of the body that is considered to be a disadvantage if compared to Potts shunt [2][3][4][5]. Experimental studies have shown that the "ideal" volume of right-to-left shunt at atrial level after atrioseptostomy is 11-15% of the cardiac output [6,7].…”